抗N-甲基-D-天冬氨酸受体脑炎患者的睡眠障碍研究

Sleep disorders in patients with anti-NMDAR encephalitis

目的探讨抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎患者的睡眠障碍情况。方法选取2014年1月至2021年1月在武汉市长江航运总医院门诊及住院收治的抗NMDAR脑炎恢复期患者12例,年龄和性别匹配的健康对照组12例。所有对象均进行体质量指数(BMI)评价及视频多导睡眠图(VPSG)监测,比较2组睡眠总时间、睡眠总效率、入睡潜伏期、非快速眼动(NREM)睡眠N1期占比、NREM睡眠N2期占比、NREM睡眠N3~4期占比、REM睡眠占比、意识模糊觉醒例数、周期性肢体运动、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO_(2)),评估抗NMDAR脑炎患者急性期及恢复期睡眠情况。结果抗NMDAR脑炎患者恢复期睡眠结构没有变化,但从VPSG记录显示,4例患者出现了多次意识模糊觉醒,意识模糊觉醒例数与健康对照组比较,差异有统计学意义(P=0.047);12例急性期患者中有7例表现失眠,占比58.3%,而在恢复期6例患者出现白天过度嗜睡,占比50.0%,2例出现失眠,仅占比16.7%。结论抗NMDAR脑炎患者会出现多种睡眠问题,从急性期到恢复期有睡眠模式的变化,急性期以失眠为主,恢复期出现白天过度嗜睡,在NREM睡眠期出现意识模糊觉醒。

Objective To explore the sleep disorders in patients with anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis.Methods A total of 12 patients with anti-NMDAR encephalitis admitted to the outpatient department and inpatient department of Wuhan General Hospital of the Yangtze River Shipping in the recovery period were included.Twelve age-and sex-matched healthy participants were included as controls.All people were evaluated in body mass index(BMI)and video-polysomnography(VPSG).Data were compared between the two groups,including the total sleep time,total sleep efficiency,sleep latency,non-rapid eye movement(NREM)sleep N1 period,NREM sleep N2 period,NREM sleep N 3 to 4 period,REM sleep,number of cases of blurred arousals,periodic limb movements,AHI,and LSaO_(2).The sleep status of patients with anti-NMDAR encephalitis at acute and recovery stages were evaluated.Results The sleep structure of the patients with anti-NMDAR encephalitis did not change during recovery.Four patients showed blurred arousal on V-PSG,compared with healthy controls.The number of cases of blurred arousals had a statistical difference between the two groups(P=0.047).In the acute stage,7 cases(58.3%)showed insomnia;while during the recovery stage,6 cases(50.0%)had hypersomnia,and only 2 cases(16.7%)showed insomnia.Conclusion Sleep disturbances are frequent in patients with anti-NMDAR encephalitis.They show a temporal pattern,predominantly insomnia at onset and hypersomnia during recovery,and can occur with confusional arousals during NREM sleep.